Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study

BACKGROUND: Many risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures. However, little is known about the short-term absolute risk (AR) of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women. METHODS: In total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms. RESULTS: In the total group, 12.5% (95% confidence interval (CI) 10.1–14.9) of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score <-1.0) were retained as significant predictors with significant interaction. Women with a recent previous fracture (during the past 5 years) had an AR of 50.1% (95% CI 42.0–58.1) versus 21.2% (95% CI 20.7–21.6) if the previous fracture had occurred earlier. In women without a fracture history, the AR was 13.8% (95% CI 10.9–16.6) if BMD was low and 7.0% (95% CI 5.5–8.5) if BMD was normal. CONCLUSION: In postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD

Printed In Great Britain The Prevalence of Asymptomatic and Unrecognized Peripheral Arterial Occlusive Disease

Background. The prevalence of peripheral arterial occlusive disease (PAOD), including asymptomatic cases and cases unknown to the general practitioner (GP) was estimated in 18 884 men and women, aged 45-74 years, on the list of 18 general practice centres (GPC). Methods. The study population (n = 3171) consisted of a stratified sample of the total population. In the GPC data were collected on intermittent daudication (IC), peripheral pulses, vascular risk factors, cardio- and cerebrovascular disease (CCVD) and the ankle brachial systolic pressure ratio (AB ratio) and PAOD was defined as an AB ratio &lt;0.95 on two consecutive occasions. Results were recalculated for the total population. Results. The prevalence of PAOD was 6.9 % (95 % confidence interval [Cl]: 5.7-8.2%), of which one-third (2.2%) had an AB ratio &lt;0.75. The prevalence of IC was 6.6 % (95 % Cl: 5.2-7.9%), a quarter of which (1.6%) met the classic WHO criteria. Peripheral arterial occlusive disease did not occur significantly more often among men than among women but men suffered more often from an advanced stage of PAOD. Of all PAOD cases, 22 % were symptomatic. The proportion of symptomatic cases correlated positively with higher age, male gender and lower AB ratio. Among asymptomatic PAOD cases the prevalence of concomitant CCVD was three to four times as high as in the group of subjects without PAOD. Of all PAOD cases 68 % were unknown to the GP and this group mainly represented less advanced cases of atherosclerosis. However, among PAOD cases with an AB ratio &lt;0.75, 42 % were unknown to the GP